Trichotillomania (TTM) is a chronic impulse control disorder characterized by pulling out one's own hair, resulting in noticeable hair loss. Although the disorder typically begins in early adolescence, there are few data available to guide treatment choice for youth with TTM. Our research group developed and empirically evaluated a manualized BT program for pediatric TTM (R21 MH61457 - M. E. Franklin, PI), completing what is to our knowledge the only randomized controlled trial (RCT) of any treatment for pediatric TTM. Results indicated a clear advantage for BT over a Minimal Attention Control (MAC) condition at post-treatment, with gains well maintained up to six months for those randomized to BT. With this encouraging preliminary work as our starting point, we now seek to replicate the findings in a larger sample and extend them by employing a more scientifically rigorous comparison condition, Supportive Counseling (SC), to allow us to rule out non-specific factors such as psychoeducation and therapist contact time as the reasons for TTM symptom reduction. Our primary specific aims are to: 1) compare the efficacy of BT to SC for treating TTM at post-treatment (week 8); and 2) examine maintenance of BT gains through an eight week maintenance phase (week 16). We also plan to: 3) examine maintenance of BT gains through a naturalistic follow-up phase (weeks 28, 40); and 4) explore predictors of acute (week 8) and long-term (weeks 16, 28, & 40) response to BT, including comorbidity, initial severity, and family psychopathology. Public Health Relevance: Development of an efficacious and transportable treatment for youth with TTM may provide front-line clinicians with specific strategies for helping these youngsters now. Moreover, effective treatment delivered closer in time to the onset of the disorder may serve as a form of prevention for the psychiatric sequelae that appear to develop in the wake of TTM in adults. The proposed study constitutes a logical and necessary next step in developing an adequate evidence base for BT in pediatric TTM, and lays the groundwork for future transportability studies where its effectiveness can be examined in the settings where most families can access pediatric mental health services. Development of an efficacious and transportable treatment for youth with TTM may provide front-line clinicians with specific strategies for helping these youngsters now. Moreover, effective treatment delivered closer in time to the onset of the disorder may serve as a form of prevention for the psychiatric sequelae that appear to develop in the wake of TTM in adults. The proposed study constitutes a logical and necessary next step in developing an adequate evidence base for BT in pediatric TTM, and lays the groundwork for future transportability studies where its effectiveness can be examined in the settings where most families can access pediatric mental health services. [unreadable] [unreadable] [unreadable]